Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Here’s how it works. Companies charge fees or “reasonable payments associated with the removal, transportation, implantation, processing, preservation, quality control and storage of a human organ,” according to the National Organ Transplant Act of 1984.

But these fees are illusory, argues Michele Goodwin, author of “Black Markets: The Supply and Demand of Body Parts.”

“There’s such a markup that they’re really much more like a payment, not a nominal fee,” she said. “We are talking about business operations that have strict pecuniary interests.”

Money is being made hand (which goes for $350 to $850) over foot ($200 to $400 each), according to the new book “Body Brokers” by Annie Cheney.

Companies generating huge revenues
Executives are earning generous salaries, and the companies for which they work are generating huge revenues thanks to advances in modern medicine that can transform tissue into a variety of implants such as a skin graft or bone chip.

But this is an industry unlike others, comprised of a hodgepodge of players, all of them angling to get tissue from the 20,000 people who donate their bodies a year.

On one side of the industry sits for-profit companies that process the tissue. On the other, competing nonprofits such as tissue banks that make up the backbone of the industry.

Tutogen Medical Inc., CryoLife Inc., LifeCell Corp., Regeneration Technologies Inc. and Osteotech Inc. are among a handful of for-profit companies that dominate the tissue landscape and are publicly traded.

The companies generated more than $363 million in revenues in 2005, and have vast tissue-bank networks that provide cadaver tissue to feed their booming businesses.

Revenues for LifeCell, for instance, grew 55 percent in 2005. And in the first financial quarter of 2006, earnings more than doubled for LifeCell, a New Jersey company that markets a popular product called AlloDerm for plastic reconstructive, general surgical and burn applications.

Nonprofits not far behind
But these companies have to battle to keep pace with their rival nonprofits — the ones that claim an altruistic mission.

Four of the largest nonprofits, LifeLink Foundation Inc., LifeNet Inc., AlloSource and Musculoskeletal Transplant Foundation Inc., generated about $442 million in revenue in 2004, according to their latest tax returns available to the public.

Race to find more donorsGoodwin, who’s also director of the Health Law Institute and the Center for the Study of Race and Bioethics at DePaul University College of Law, says marketplace dynamics have spurred a race to find suitable donors, and that can lead to trouble.

Last year, a New Jersey firm called Biomedical Tissue Services was accused of plundering corpses and selling the parts without donor permission.

BTS helped fill the tissue gap, providing more than 13,000 pieces of tissue to Blood and Tissue Center of Central Texas, LifeCell, Regeneration, Tutogen and a small operator called Lost Mountain Tissue Bank in Georgia.

“There is always a need for additional donors to meet demand and this was a potential source,” said Marshall Cothran, chief executive of Central Texas in Austin, who said the majority of his business comes from blood services.